Covid policies and harms to children

An update to HART’s March 2020 Evidence Briefing

Dr Ros Jones, Retired Paediatrician & Dr Zenobia Storah, Clinical Psychologist

                                       

In all actions concerning children, the best interests of the child should be a primary consideration (Article 3 UN Convention on the Rights of the Child) [1].  We should put children first in all that we do.

Children and young people are the future of any society. They are self-evidently vulnerable and require the care and protection of their families and of the wider community. Prior to the Covid Pandemic, in the UK, the UN Convention on the Rights of the Child was universally endorsed by all professionals whose work involved children and young people. Our legal, clinical and education systems reflected the Article 3 principle that children’s best interests should be paramount. It has been disturbing to observe that, from March 2020, with the arrival of the novel Covid-19 in the UK, the resulting collective anxiety led the government, the civil service, most relevant public bodies and institutions to forget their commitment to this principle. Public Health policy and government action during the last two years has repeatedly failed to consider children and young people’s needs, let alone ‘put [them] first’. Over the course of the pandemic, children and young people were routinely subjected to harmful and unevidenced interventions, despite decades-worth of accumulated and accepted knowledge about the conditions required for their physical and mental well-being and their social, emotional and cognitive development.

Mounting evidence of harms to children over the past two years suggests that government response placed too much weight on the need to protect vulnerable adults at the expense of the less immediately obvious (but more long-term) damage to the well-being and futures of our children and young people.

It is essential these harms are acknowledged by government and wider society, and the impacts fully understood, so that we appropriately support recovery. This document catalogues the harms caused to children and young people by Public Health measures implemented in an attempt to control the spread and impact of the COVID-19 pandemic. It is an extensive update on the evidence which we published in March 2021.

Closing of Schools

During the pandemic, schools in the UK were twice closed to most children (between 20th March and July 2020 – with some year groups returning in some capacity in Summer term 2020 – and again between 6th January 2021 and 8th March 2021).

Children in the UK experienced some of the longest periods of school closure in Europe. Between March 2020 and July 2021, children were out of the classroom for nearly half (44%) of all school days [2].

An internal government briefing in November 2020 outlined the increasing concern and evidence of harms caused by school closures during the first UK lockdown (March-July 2020) [3]. It listed multiple harms including risk to educational outcomes (especially for the most disadvantaged children), exacerbation of attainment gaps and other inequalities, impediment to timely identification of learning needs, impairment to the mental and physical health of children and young people, and to their cognitive, social and emotional development. The report highlighted additional risks to vulnerable children due to reduced access to essential services and questioned the effects of extended periods of remote learning on educational outcomes.

Despite this extensive list of significant concerns being known to the Department of Education, who jointly prepared this paper with SPI-B (Scientific Pandemic Influenza Group on Behaviours) for consideration by SAGE (the Scientific Advisory Group for Emergencies) in November 2020, schools in the UK closed for a second time in January 2021.

Public Health England acknowledged in January 2021 the huge mental health and educational impacts and that schools play only a small part in viral transmission [4]. In the same month, Professor Russell Viner, President, Royal College of Paediatrics & Child Health and a member of SAGE said, ‘When we close schools we close their lives – not to benefit them but to benefit the rest of society’ [5].  A BMJ editorial published on 23rd February 2021 stated that ‘Closing schools is not evidence based and harms children[6],going on to say that ‘keeping schools open should be the UK’s top priority’.

Despite known harms (evidenced by the impact of school closures in 2020) and these concerns being raised by many experts in the field, government did not open schools until 8th March 2021. When schools were opened, they were instructed to operate a test-and-trace system that led to many more lost days of education for the nation’s children. The scheme obliged healthy children to routinely test for Covid-19 and for contacts of children testing positive to isolate at home. By July 2021, almost a quarter of England’s pupils (1.7 million children) were absent from school, for Covid-related and non-Covid-related reasons [7].

Due to the multi-faceted role that schools and other educational/childcare settings play in society and in children’s lives, many of the harms to children listed in this document are linked inextricably to the closure of schools and repeated school absences due to the testing system that operated in schools between March 2021 and February 2022.

Nurseries, schools and colleges are places of education, as well as socialisation. They are child-centred places of safety which promote social, emotional and cognitive development. Crucially, they also play a key role in monitoring the health and development of children, the timely identification of additional needs, the implementation of appropriate interventions to address such needs, and, especially, in safeguarding children from harms in family homes and the wider community.

In considering the impact of school closures on children and young people’s education, emotional and physical well-being, it is also necessary to remember that they cannot be understood in isolation. During both lockdowns that involved school closures, they were accompanied by other restrictions (e.g. on social interaction in the community, cancellation of sporting and other extra-curricular activities, disruption to family and friendship networks) as well as increased pressure on households and families (e.g. due to parents working from home and home schooling [8], financial pressures [9], adults struggling with mental health and relationships [10], and in some families increased levels of substance misuse [11,12] and domestic violence [13]).

The following evidence outlines the myriad reasons why nurseries, schools, colleges and other facilities providing social, educational, extra-curricular and sporting opportunities for children and young people, should never again close to mitigate the spread of COVID-19, and why unevidenced practices such as masking and the routine testing of healthy children and contact tracing (that led to repeated school absences and further social isolation) should not be advised in any future outbreaks.

Risks related to Covid-19 transmission and infection

  • Children are at extremely low risk from COVID-19. Deaths of six previously healthy children were recorded for the whole year 1/3/20-1/3/21, which included two winter waves [14].
  • They are also much less likely than adults to transmit the virus, indeed living or working with young children reduces the risk of severe disease[15,16].
  • Given the minimal transmission of SARS-CoV-2 outdoors [17], the essential role of sunlight and outdoor activity for health and well-being [18] and the huge benefits of children’s extra-curricular activity, play and sporting events to their well-being and development [19], the restrictions on outdoor socialising and extra-curricular activity during the national lockdowns seems likely to have had minimal public health benefit and contributed disproportionately to mental and physical harm to children [20].
  • The impact of the harms of many public health measures and school closures (summarised below) appears to have been disproportionate to any benefits to children themselves or to wider society[3,5,6,21].

Harms to Education

  • Existing research shows that even a few days extra learning loss can have a large impact on education achievement and life outcomes [22,23].  Children in the UK suffered big losses of around 60-65 days by July 2021 [24], losses that were much bigger than any previously studied.
  • Several studies [25],[26]  have confirmed that learning losses suffered during the pandemic are manifested in stark gaps in attainment between children from poorer backgrounds and their more privileged counterparts. Academics at LSE concluded a likely consequence of such extensive loss of education to be significant decline in social mobility levels for younger generations 24.
  • By July 2021, Government-commissioned reports were starting to quantify harms to learning due to school closures and Covid-related absences [27]. At that point, detailed information only existed for the Autumn term of 2020. Relatively little information existed about secondary school pupils, and no studies had examined the impact of school closure on the learning of children in year 10 and above.
  • Evidence summarised for the government suggested that primary school children were ‘about a month’ behind learning expectations in the Autumn term of 2020, and that disadvantaged children had been disproportionately affected. Other research identified a gap of about 2 months progress in reading and maths for Year 2 pupils, but a progress lag of around 7 months for the most disadvantaged pupils 23.
  • The House of Commons Education Committee published a report summarising the damage to children caused by school closures in March 2022. This paper concludes that school closures were ‘nothing short of a national disaster’ in terms of children’s attainment and mental health. It urgently questioned whether the government’s ‘catch up’ programme was fit for purpose 23.
  • When schools were opened during the pandemic, mitigations were put in place that arguably increased children’s anxiety and impaired their educational, social and emotional functioning. Children were kept apart from other year groups, prevented from engaging in whole-community activities, and were constantly reminded through public health messaging, teacher instruction and behavioural practices (e.g. one-way systems and masking) of on-going threat [28].
  • Twice-weekly asymptomatic testing for SARS-CoV-2 was introduced in secondary schools in the UK in January 2021, a measure apparently agreed with teaching unions in order to ensure support for the opening of schools. Although guidance was specific to secondary education, many primary schools, nurseries and pre-schools also requested routine testing of children in their care. Regular self-testing by students has also been required at colleges and universities.
  • There is no evidence that any proper evaluation or cost-benefit analysis of this measure was made by government, despite concerns about the efficacy of this practice [29],[30], its value in terms of use of resources at a time of heightened need within the education system following lockdowns [31],the impact on attendance of children who had already missed significant amount of face-to-face teaching during lockdowns[32] and the potential for physical[33],[34] and psychological harms [35],[36] to children and young people.

Harms to Early Development, including Speech and Language

Mounting evidence suggests that the development of our very youngest children was particularly damaged during lockdowns, closures and disruptions to daycare, nurseries, preschools and reception classes (Early Years provisions). This has become increasingly apparent as the children who were passing through the critical early years developmental period between 2020 and 2021 have arrived in preschool and reception classes. It has long been known that early development (particularly between birth and three years of age, but throughout early childhood) is fundamental to shaping lifelong learning, behaviour and health [37].

Early childhood offers a critical window of opportunity to shape the trajectory of a child’s holistic development and build a foundation for their future. The three prime areas of development – Personal, social and emotional development, Communication and language, and Physical development are time-sensitive because of biological factors that enable rapid brain connections, particularly in the first three years of life but continuing throughout early childhood.  All three processes are always in action for a young child. In every activity, the child experiences feelings and a developing a sense of self and others, is physically engaged through their senses and movements, and is learning to understand and communicate with others.  It is through these experiences that a child accesses the world around them and relationships with other people, which in turn opens the door to learning in all areas [38]. Early Years development is therefore a time of enormous opportunity, but also huge risk.

Developmental steps missed at this early crucial stage are much harder to address later on, so it is crucial that children’s interactions and experiences in the first few years, support development in these fundamental areas. Research has consistently shown that good early childhood development (which requires opportunities for new experience, play and exploration, and multiple social interactions) will have a direct positive impact on a child’s long-term health outcomes and will improve future opportunities, school attainment and even earning potential [39].

It is therefore not surprising – and could have been anticipated by policy-makers – that disruption to small children’s development through stay-at-home orders and closures of play facilities, playgrounds, playgroups and nurseries – has led to developmental delay (with potentially severe long-term consequences) for many, particularly for the most vulnerable and disadvantaged.

  • An Ofsted briefing based on inspections of 70 education providers in January and February 2022 raised concerns about the numbers of young children whose social development is delayed. Amanda Spielman, Ofsted’s Chief Inspector, observed that the stay-at-home orders and closures of provisions had dramatically reduced young children’s social experiences and interactions and increased the amount of time they spent on screens. She also mentioned the harm caused to young children’s social development by interaction with adults wearing face masks [40].
  • Ofsted found that young children were struggling to read and respond to facial expressions, presenting in school with limited vocabulary and poor self-care skills (including toileting skills and ability to dress themselves) [41]
  • A Daily Mail investigation in June 2022 reported similar findings and reported the Education Endowment Foundation’s research which found significant numbers of four- and five-year-olds (children who were between the ages of 2 and 3 at the start of the pandemic) arriving at school with speech and language problems, trouble with social interaction and confidence and delays in walking [42].
  • The Times Education Committee reported in June 2022 that in some areas, post-pandemic, 80-90% of children were arriving in reception ‘not school-ready’. Some children were not able to say their own names, spoke in baby language, were not toilet trained and presented with delayed physical skills [43].
  • All these sources report that the poorest and most disadvantaged children – those living in small homes and with no outside play space – suffered the most during the pandemic. The Institute of Fiscal Studies has recently attempted to quantify these harms in its recent report on Early Childhood Inequalities [44]. The Institute estimates that the proportion of children reaching expected levels of development, particularly in the areas of social skills and communication, dropped by three percentage points during the pandemic, with the poorest children hardest hit. It concludes, ‘all signs point to the fact that [the pandemic response] has exacerbated social inequalities’.

During the pandemic, there appears to have been a misguided belief within government, and society as a whole, that children’s learning journeys, emotional, social and cognitive development can be interrupted and then restarted with no serious consequences. This was an egregious error, and one that should have been avoided had policy-makers attended to the wealth of accepted knowledge that exists about child development eg [45],[46] [47].

A note on ‘Remote Learning’

During devastating school closures, the idea that virtual or ‘remote’ learning was an adequate substitute for in-person teaching was promoted by government. The argument that children could access ‘high quality remote learning’ [48] was used to justify extension of school closures to the general public during the first lockdown, and on reintroduction of the school closure policy in January 2021.

Widely understood phenomena about children and young adults’ needs, behaviour and learning patterns could have informed government that remote learning was no adequate substitute for school attendance [49]. It is uniquely unsuited to children and teens, who are easily distracted, both by online and real-time activity, and unlikely to be able pay attention to academic material from their bedrooms without a closely supervising adult. It particularly fails the most disadvantaged children, in that they are less likely to have the technology, parental support and home environments suited to study [50] and also infant school children who primarily learn through play and social interaction and need high levels of adult support [51]. Remote learning is problematic for children with Special Educational Needs, and for those with complex medical needs, a clear strategy to enable their return to school was lacking [52].

Remote learning (especially alongside national social restrictions such as ‘Stay at Home’ orders) failed all child and teen, because it deprived them of unimpeded interpersonal interactions with both peers and adults that are necessary to their cognitive, emotional, and health [53],[54]. Many children experienced loneliness during school closures and lockdowns (despite spending on average three hours a day on social media) which contributed to the development or exacerbation of mental health disorders [55]. Remote learning also failed to enable the safeguarding benefits to children that the school environment provides, as tragically evidenced by the increased levels of abuse and neglect of vulnerable children whose well-being could not be properly monitored by teaching staff during school closures [56], and resulting, in a number of high-profile cases, to deaths of children [57],[58],[59].

School closures: in summary

Children’s learning has been damaged by school closures and repeated absences. The consequences have been particularly severe for the poorest and most vulnerable children in our society, and for the very young. In the UK today, 105,000 children remain out of education or ‘severely absent’, having never returned to school after school closures [60]. Many are the most vulnerable of our young people and are at risk of abuse and criminal or sexual exploitation.

In December 2021, Jaime Saavedra, World Bank Global Director for Education, warned that the potential increase of ‘Learning Poverty’ due to these policies was likely ‘to have a devastating impact on future productivity, earnings, and well-being for this generation of children and youth, their families, and the world’s economies’ [61]. Whilst surveying the damage done to many British children’s learning and development over the past two years, and attempting to learn lessons for the future, it is important to note that in Sweden, where schools for the under 16s never closed, no learning loss appears to have been experienced by Swedish children during the pandemic and psychosocial well-being of students appears to have been relatively unharmed [62], [63].

Harms to Emotional Well-being and Mental Health

There has been rising concern amongst experts about the increase in children and young people’s mental health problems in the UK since March 2020. Experts have been alerting policy makers to an impending mental health catastrophe in these age groups, greatly exacerbated by the COVID-19 pandemic and associated public health policy. Lockdowns, ‘Stay at Home’ orders, government fear messaging and school closures have led to an increase in children and young people’s isolation, loneliness and anxiety and other mental health disorders [64], [65].

Prior to COVID-19’s arrival in the UK, children’s mental health was in ‘crisis’ [66]. UK and international studies evidenced that affective disorders in young people had risen substantially since 2007. By 2017, 1 in 8 young people between 5 and 19 years had at least one mental disorder [67]. Services struggled to meet demand: one in four children referred to services in 2018 were rejected [68]. More than half of children accepted waited more than 18 weeks before accessing services [69].

From March 2020, experts alerted government to the likely increase in demand for children’s mental health services due to the detrimental impact of COVID-19 public health policy on this age group [70].

Compelling evidence has since mounted, with the publication of numerous reports which are consistent in their findings of significant increase in distress amongst children and young people [71],[72],[73]. Research has highlighted both the serious immediate and long-term implications that experiences such as loneliness, isolation and quarantine have for children’s mental health.

  • 1 in 6 young people now meets the diagnostic criteria for at least one mental disorder [74]. These findings have been matched by anecdotal evidence and distressing reports from the front-line [75].
  • The number of children presenting at Accident and Emergency departments with serious mental health presentations including self-harm, increased by 50% during the year 2020-2021 [76].
  • Children’s mental health appears to have been disproportionately affected during the pandemic. Between April and September 2021, there was an 81% increase in referrals for children and young people’s mental health services compared with the same period in 2019. The increase for adults (19 years and over) in the same period was 11% [77].
  • Eating Disorder presentations and need amongst these patients increased during the pandemic. The number of children and young people waiting to start treatment for a suspected eating disorder quadrupled from pre-pandemic levels to 2083 by September 2021. The number of children and young people attending emergency departments primarily for an eating disorder doubled from 107 in October 2019 to 214 in October 2021 [76].
  • Researchers at University College London (UCL) found that depressive symptoms such as low mood, loss of pleasure and poor concentration in adolescents increased by six per cent after Covid struck, with 60,000 more secondary aged children meeting the diagnostic criteria for clinical depression [78].
  • Serious self-harm among young people jumped during strict COVID-19 lockdowns, new research shows. Researchers at King’s College, London, found that boys needing urgent support from emergency services doubled, and then tripled for children in care [79].
  • Researchers and practitioners have observed a dramatic increase in children presenting with tics and tic-like behaviours during the pandemic, a phenomenon they explain as related to undiagnosed neurodevelopmental conditions and anxiety related to the pandemic [80].
  • Secondary school aged children in the UK were obliged to mask in schools during the pandemic, despite little evidence that this practice significantly reduces transmission [81], and despite expected social and emotional harms for children. Few attempts have been made to understand the impact upon children and the risk/benefit profile of such instruction. One large German study found that 68% of parents reported impairments to children’s well-being and happiness [82], and another German study found that despite very low infection rates within schools, children had high levels of fear and poor Quality of Life scores [83].

The pandemic appears to have taken a devastating toll on the nation’s young. The crisis presented a ‘two-fold’ problem for mental health: public health restrictions both promoted the development of mental health problems and raised significant barriers to evidence-based treatment. With children confined to their homes and isolated from community life, statutory and third-party services pared back or online, and many strategies used to ameliorate mental health difficulties banned or restricted (eg sport, family connection, school engagement, socialising), many children and young people were left to cope with deteriorating mental health without adequate support. Again, the most disadvantaged children suffered the most.

Children’s mental health was disproportionately affected and treated with casual interest by policy-makers during the pandemic, despite the fact that research tells us that children and young people’s brains are uniquely sensitive to environmental stressors with potential life-long implications [84],[85]. Overall, the global onset of the first mental disorder occurs before age 14 in one-third of individuals, age 18 in almost half (48.4%), and before age 25 in half (62.5%), with a peak/median age at onset of 14.5/18 years across all mental disorders [86]. For this reason alone, policy-makers and professionals working in areas that impact children should be extremely careful about introducing policies that have potential to harm children’s mental health and emotional well-being. During the COVID-19 pandemic, such due caution has not been taken, with devastating consequences.

Harms to Physical Health

Children and young people’s physical development and well-being necessarily requires that they live active lives. This enables cardio-vascular health, muscle development and healthy bone mass and density, all of which enables good physical health during childhood and hugely reduces the chances of poor health in adult life [87]. Outdoor activity and play are essential for optimum vitamin D production, promote better sleep, healthy eye development and reduce behavioural difficulties [88]. Social contact for toddlers and young children helps to prime their developing immune systems and there is some evidence that it increases non-covid infections.

‘Stay at home’ orders, outdoor sports bans and school closures dramatically reduced opportunities for children to engage in outdoor play, sport and social activity during 2020 and 2021, with clear detrimental consequences for children’s physical health.

  • Children were more sedentary during lockdowns. During the first lockdown, just 19% of children were achieving the Chief Medical Officer’s guidance of 60 minutes of physical activity a day [89].
  • Children from less affluent backgrounds were twice as likely as children from better off homes to not exercise [90]. Children with no outdoor space attached to their homes were disadvantaged in terms of physical and mental well-being.
  • Statistically significant increases in Body Mass Index (BMI) and reduction in physical fitness have been recorded amongst children in the UK [91] following lockdowns.
  • In 2021, the UK government’s National Child Measurement Programme recorded the greatest increase in childhood obesity rates in a single year since the programme began 15 years previously [92]. Experts attributed this dramatic increase to lifestyle changes imposed by the pandemic response, citing children’s sedentary lifestyle and huge increases (up to 4 hours) of screen time per day during lockdowns and school closures.
  • A further detrimental impact of reduced outdoor activity for young people and increased screen time appears to have been an increase in myopia in children following lockdowns. Studies have found that home confinement during the COVID-19 pandemic appeared to be associated with a significant myopic shift for children. Younger children’s eyesight was more likely to be impacted than at older ages, most likely due to their eyesight being more sensitive to environmental changes during a critical stage of development [93].
  • A recent outbreak of hepatitis [94] in young children (median age of 3 years) has been attributed to a combination of two different viruses, AdV-F41 and AAV2. It has been postulated that this unusual co-infection has resulted from reduced exposure to viruses during lockdowns [95]. Outbreaks of RSV bronchiolitis and various other infections have been attributed to the so-called ‘immunity debt’ [96].

Disruption to children’s health services caused by dramatic scaling back of healthcare services and increased difficulty accessing routine care has also taken a toll on children’s health, with further potentially far-reaching consequences.

  • During the lockdowns, the Chief Dental Officer (CDO) advised that all routine, non-urgent dental care should be stopped and deferred.
  • As a result, children and young people in the UK, including a group of infants who would have been eligible for their first dental visit (365 000, i.e., half of the birth cohort in the previous year) were denied access to routine dental care with potentially catastrophic consequences for their oral health and general well-being[97]. Again, children from less affluent backgrounds have been disproportionately affected.
  • Children’s presentations in paediatric emergency care departments reduced dramatically (by more than 50%) during the national lockdowns, raising concerns about children’s safety, their well-being and ability to access to essential care for serious pathology during these periods, exposing them to avoidable harm and potentially catastrophic consequences for their longer term health [98].
  • Concerns were raised about delayed presentations due to parental adherence to ‘Stay at Home’ orders and government messaging about reducing strain on health services. Paediatric oncologists reported a reduction in referrals for cancer assessment which raised concerns about undiagnosed cancer in the community and late presentations which can amount to avoidable harm [99].
  • The lockdown also resulted in declining childhood immunisation rates, especially for the measles-mumps-rubella (MMR) vaccine at one year of age, raising concerns of future outbreaks of vaccine-preventable diseases [100]. Concern has arisen over reduced rates of polio vaccination at a time when live vaccine strains are circulating[101].

Harms caused by Children’s Services scaling back or changing practice

During the pandemic, and particularly in the initial stages, social care and third sector organisations scaled back their services or were obliged to work in remote or socially distanced ways due to public health guidance about social distancing. Many voluntary sector or charity-run provisions providing essential services to our most vulnerable families closed their doors because they could not guarantee the ‘safety’ – specifically in terms of COVID-19 transmission – of clients and staff [102]. As a result, the safety and well-being of the most vulnerable – in terms of risks other than that posed by COVID-19 – were often compromised.

The number of families affected by these changes is hard to quantify and estimates vary significantly. A Mencap survey [103] in July 2020 found two-thirds of families said the amount of social care support received from the local authority had fallen ‘a lot’ compared to the amount received before the Covid-19 pandemic, while Parkinson’s UK found that nearly half of people receiving paid social care, both privately funded and council-funded, had seen a reduction in social care support [104]. These experiences were shared by families of children and teens – especially those with complex needs including disability [105],[106].

Due to restrictions and changed working practices, many vulnerable children were less visible to professionals, increasing the risk that evidence of harm to them was not being identified. Even when the restrictions were lifted, and most children returned to school and could re-engage with some services, many professionals were not able to see these children again, due to public health measures in schools and because some services were not yet being offered or were running at a lower capacity than pre-pandemic levels [107]. As a result, between 2020 and 2022, there were delays in identifying vulnerable children and their needs, and families had fewer opportunities to ask for and access help. Access to therapeutic and respite services for disabled children in particular continued to be limited well into 2022, leaving children and families without support. A number of groups of vulnerable children were particularly affected – with potential long-term and devastating impact on development, educational prospects, physical and emotional health.

  • Despite increase in spending on Children’s social care those vulnerable to neglect and abuse were exposed to additional risk during the pandemic. Restrictions due to school closures and restrictions on social interaction with family and the wider community rendered them ‘invisible,’ especially at a time when pressures within families was hugely increased by financial and mental health strains for adults, and because of lack of wider community support whilst families were isolated at home [108]. Referral rates during the lockdown periods were significantly lower than in comparable periods. Between May 2020 and January 2022, referral rates were 10% lower than for comparable weeks between 2017 and 2020.
  • The NSPCC reported that during the period between March 2021 and March 2022, child neglect and cruelty offences rose by a quarter as compared with the same period the previous year. The charity pointed to the strain that many families experienced during the pandemic and the difficulties in terms of accessing early help. 56
  • Experts also highlighted an increased risk of female genital mutilation occurring during prolonged school absence [109].
  • A number of high-profile child abuse cases, tragically involving the death of a child, included elements of difficulty identifying, monitoring and intervening in early signs of danger due to lockdown restrictions and the impact on social networks and services [110],[111],[112].
  • During restrictions, due to difficulty providing regular face-to-face oversight, and delays in the Family Courts, many social workers took a particularly cautious approach to stepping down care, meaning that many families or children in care did not receive in-person support, remained in limbo for review of their cases, putting additional strain on vulnerable families and their attempts to re-start their lives on hold [113].
  • Young people leaving the care system – some of our most vulnerable young people – were particularly affected by isolation during the lockdown periods. The mental health of this group has been negatively impacted with lack of access to good quality support and advice, and smooth transition to adult services, disrupted. It is known that care leavers are particularly vulnerable to mental health difficulties, homelessness, addiction and criminal and sexual exploitation and require significant support in their transition to independent and healthy adult lives [114].
  • Young people in custody in our prisons and Youth Offender Institutions are also amongst our most vulnerable and traumatised. This cohort experienced particularly harrowing circumstances during COVID-19 restrictions. The regime in prisons was severely restricted, with most children being placed in prolonged solitary confinement. There were no face-to-face visits, no face-to-face education in the majority of establishments and no therapy. Children experienced difficulties in accessing the support they need to plan for release. The usual safeguards that exist, including on-site advocacy services, were no longer present [115]. These young people were exposed to an unacceptable level of distress and risk, with potentially devastating and far-reaching consequences.
  • Children with parents in prison faced up to twelve months with no contact with their parents during the pandemic, due to restrictions on face-to-face visits and the absence of video call facilities for prisoners until January 2021. This loss of contact had a detrimental impact upon the relationships, well-being and mental health of this particularly vulnerable group of children who had previously experienced positive and regular interactions with parents in prison [116]. In many cases, the effects of this loss of contact and disruption to family relationships are likely to be long term and will affect family reunification and resettlement after imprisonment.
  • Children with disabilities were disproportionately negatively affected by pandemic restrictions, with advocacy groups highlighting that often their basic rights and needs were not met, including access to education and essential support services including speech and language therapy and other paediatric therapies. Families of these children were put under particular strain due to reduction in services and mandates that restricted access to family and social support networks. Violation of these children’s rights included their right to life, with concerns raised that treatment that could extend or save lives of people with complex needs, were made more difficult to access during lockdowns and reduced their access to healthcare [117].

Recovery

During the pandemic, Public Health policy produced mandates, restrictions and guidance that undoubtedly caused significant harm to a whole generation of children and young people, and particularly the most vulnerable – those at risk of harm, those who are socially and economically disadvantaged, and those with complex and additional needs.

It is imperative that we reflect fully on the mistakes made and the harms caused by misguided policy that disproportionately damaged a cohort that was never at serious risk of severe illness caused by COVID-19. In particular, we must examine and quantify further the harms caused by the closing of schools, the scaling back of essential services and social restrictions that limited necessary support and maintenance of significant relationships for children and families so that no government reaches for these tools in an attempt to manage a national emergency ever again without a full cost/benefit analysis of what it at stake. The Education Select Committee chairman, Robert Halfon MP, and also the Children’s Commissioner have been outspoken about the impact of school closures.  A Ten Minute Rule Bill which would designate schools as ‘essential infrastructure’ has passed its first hurdle and if successful would mean that schools could not be closed in future without full parliamentary debate and approval [118].

As we accept a state of ‘living with the virus’, we must prioritise children and young people’s recovery. Resources should now be redirected towards promoting educational recovery, physical health and emotional well-being, with particular focus on socially and economically disadvantaged children for whom educational, developmental and health outcomes have been most grievously affected. Policy-makers and professionals should be reminded of the importance of emotional health and physical well-being in enabling all children to thrive. The principles of trauma-informed practice – a concept promoted and accepted widely in schools and colleges pre-pandemic, through initiatives such as THRIVE [119] and the Trauma-Informed Schools programme [120] – are urgently required to promote recovery, with programmes developed that recognise the importance of outdoor activity, sport and fitness for our children’s physical and mental health. These principles should also be present in all settings where young people learn and reside – in our schools, our Children’s Homes, our Young Offenders’ Institutes and our prisons.

This document has shown how, shockingly, during the COVID-19 pandemic the UK’s government and most public bodies appeared to forget their commitment to the UN Convention on the Rights of the Child 1. It is clear that over the past two years, children’s best interests have never been paramount.

As a society, we must ask ourselves how we got to a point where young people were routinely subjected to harmful and unevidenced interventions. As we support their recovery, we must ask government to commit to children’s interest and to ensure that they are never subjected to such experiences again.

Acknowledgements:

This paper has been published on ResearchGate DOI: 10.13140/RG.2.2.26598.29762.  

It is an extensive update on the evidence which we published in March 2021.


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